08.06.2016

Wild Grey Yonder: Psychiatry, Stoicism and The Sopranos

Dan Kelly examines his mental health through the lenses of professional psychiatry, ancient philosophy and contemporary TV. This article discusses depression; if that's something you're struggling with, consider reaching out to friends, family or professionals for help and support.

The fifth day lasted seven years
While he worked in the Asylum laundry
Never out of the steam.
The sixth day he told the head doctor,
'I am the Light in the Void;
I am who I am.'
The seventh day he was lobotomised;
The brain of God was cut in half.

- James K. Baxter, The Māori Jesus

When I was at university, my professors were obsessed with grey. The old black and white arguments of psychology had taken a beating in the years preceding, and these professors were at great pains to ensure students understood the new orthodoxy. We weren’t 'blank slates', born clean at birth, ready for the world to leave its mark on us; but neither were we the pre-programmed robots of genetic determinism, doomed to live our DNA. Life just isn’t that simple. Instead, we are each the complex and ongoing outcome of the interplay between the two – not a number, but an equation: genes x environment.

Despite all its scientific support, this new story of indeterminacy has been slow to permeate the mainstream. In season six of The Sopranos, an increasingly frustrated Tony moans to his psychiatrist about the troubles of his son A.J. Like Tony, A.J. is prone to depression – yet instead of compassion, all we see is anger. A.J.’s sensitivity is weakness; Tony is consumed with guilt about passing it on to him, and, despite his own experiences, remains frustrated that A.J. won’t buck out of it.

As Tony’s psychiatrist so poignantly points out, “depression is rage turned inwards”, but Tony refuses to see his role. It is beyond his control, “in his blood”, inescapable and itself a source of frustration, for such narratives of rigidity are the cause of further sorrow, the self-hate that fuels the cycle: I am depressed, so I am depressed.

These are frames that run deep, and it’s no small task to unpick them.

I write this not as some academic commentary, but as someone who has lived this logic, struggled with its contradictions and steadfast refusal to heed reason. These are frames that run deep, and it’s no small task to unpick them. So, let’s start with a caveat. There’s no denying depression’s genetic components – the range of human sensibility, physiology and neurochemistry that predispose different people to the emotional and physical responses clinically defined as 'depression' – and yet nothing is as fixed as we have been led to believe.

In 1980, the American Psychological Association released the third edition of their Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-III. The book sets out the symptoms, diagnoses and conditions collectively referred to as “mental illness”, and was a considerable revision of its predecessor. In the years since, the rate of pathology has skyrocketed. But as William Davies points out in his book The Happiness Industry, this is no surprise. Not only did the DSM-III massively increase the number of categories of mental illness (from 180 to 292), it also fundamentally changed how they were viewed. In a shift towards the empirical focus of the so-called “hard sciences” (and their perceived legitimacy), mental illness was cast as a question of classification: “a dispassionate, scientific guide for naming symptoms.” However, in doing so psychiatry cut itself off from the society it operated in. No longer was it possible that a specific symptom might be “an understandable and proportionate response to a set of external circumstances”; instead they were personal issues, deficiencies, to be individually treated and carried.

In my case, the slow and insidious creep of what I would later come to recognise as depression was one that I could have easily felt stuck with. I had good friends, food on the table, a well-paying, flexible job – what cause did I have for grief? Yet there it was, constricting and undeniable, the dulling of a life I had once enjoyed. My mum wouldn’t admit it, but she was worried. There were murmurings of family history, chemical imbalances, whispers that perhaps it was the sort of thing “you just have to learn to live with.”

My mum wouldn’t admit it, but she was worried.

In a way, she’s right. There wasn’t any one thing responsible for where I found myself, but a whole accumulation, united by what I now see as a misguided tendency towards taking things personally. There is no shortage of injustice in the world, and the more I learned, the more desperate it came to seem. I felt hemmed in, helpless – what could I do?

Change became imperative. I quit my job, left the country, and started to unpick the tangle in my head: why did I feel this way?

The line between sane and insane is a shifting one, and psychiatry’s binary approach has long been criticised. Even before the revision of DSM-III, opponents had condemned the stigma surrounding diagnosis, with psychiatrists such as R.D. Laing advocating treatment of mental illness as part of a larger healing process: the search for an authentic self. “Madness need not be all breakdown. It may also be break-through. It is potentially liberation and renewal as well as enslavement and existential death.”

At the start of Season 6 of The Sopranos, Tony is shot. As he recovers in hospital, he notices a strange note among the usual well-wishing. It is an Obijawe proverb: "Sometimes I go about in pity for myself, and all the while, a great wind carries me across the sky." I’d seen the episode before, but when this came up – on my laptop, some five months after leaving – it finally all made sense. As the Stoics wisely taught, there is the world, the huge chaotic mass of things you can’t change, and then there is you, your thoughts and how you choose to structure them. The wind is always there, but my pity – that was from me. It didn’t matter what had brought me to this point; I could always reassess, reframe things. It wasn’t so much my background or the world, fucked as it is, but who I thought I was, what I felt I had to do.

Marcus Aurelius, Roman Emperor and important Stoic philosopher.

This isn’t to say that the huge morass of emotion is “all in your head” or that those suffering depression should “just get over it”. Mental health is a deeply personal topic; I can only speak for me. I knew there were external factors – my job, late-stage capitalism and all its economic and environmental instability. What I didn’t know was that these were bound to internal ones: my thoughts and attributions, how I responded to the world around me. Part of the problem was feeling responsible for things beyond my control. Feeling isolated, stuck. And every time I had a negative thought, it primed me for another, made its occurrence more likely, further entrenching the feelings of frustration, isolation and impotence.

The Stoics taught a different worldview. “Choose not to be harmed – and you won’t feel harmed. Don’t feel harmed – and you haven’t been.” At its core Stoicism is about practice, detachment and exercising philosophy through action. Like the Cognitive-Behaviour Therapy that seeks to evoke it, Stoicism is a tool, a way to be in the world. It’s up to you how you use it.

As his psychiatrist Dr Melfi figures out in the show’s final season, Tony Soprano has no desire to change. His depression is simply a pain in his ass, something he would like gone so that he can better project what all his accompanying panic attacks contradict: that he is the boss, in charge, in control. His therapy, and its ultimate futility, is a crucial part of the show’s pathos: useful only to sustain its cause.

Through the distance of the Stoics I saw what my rage had been: the world’s violence reflected and contained, self-hate and the constriction that validates business as usual. I saw our indeterminacy, a new environment and with it a new outlook, new opportunities.

I’ve recently realised something else. I was like Tony, in one small way: in my search for a ‘cure’, I thought that things could be solved definitively, that I could put a full stop after depression. I thought I could take my new knowledge and move on – ‘as if it never happened.’ But it did happen, and, for the most part, the external factors that triggered it still exist. The wind goes on, but so do I. There is always more to learn.

In my madness (and all that followed) I saw change, the counter to anxiety that is action. Not alone, as I like Tony once felt, but together, the strength born of solidarity, best captured in the school of thought that says: to be well in this world one must contribute to its healing – this being but one piece.